In Karel Schoeman’s novel, Another Country, Versluis, an
affluent and educated Dutchman diagnosed with tuberculosis, immigrates to
Bloemfontein, South Africa, to convalesce. Bloemfontein in the 1870s, located
within the remote interior of the Free State, is little more than a dusty
outpost populated by first- and second-generation German, Dutch, and English
inhabitants. As the novel quietly unfolds, Versluis’s tenuous recovery, and
subsequent regression, are punctuated by his observations of the community’s
struggle to both preserve and break from European culture to form a distinct
South African identity.
Whereas Versluis cherishes his familiar
Dutch customs and courtesies, here, in Bloemfontein, he must adapt to the
community’s irregularities and gaucheries. Nevertheless, he is regularly astonished
by the town’s culture of insouciance—a lack of punctuality, etiquette, and
municipal orderliness; its sometimes frowzy fashions; disregard for
conservatism; and ease among poverty, violence, and isolation. His
observations, however, are not the mordancies of a snobbish European, but a
wrestling with his sense of profound alienation as a precariously ill man living
abroad in a strange country.
Informed that his case is terminal,
Versluis resigns himself to the inescapable state of his life. With fresh
sensibility, he embraces life in Bloemfontein, becoming more receptive to its
people and daily life. Particularly, for Versluis, the veld—with its rocks,
dust, succulents, and solitude—takes on a potent and portentous symbolism, as
an immutable and implacable presence (and emptiness), much akin to the illness
that is killing him. Within this ponderous flux of change, of a gradually
evolving Africa, Versluis peacefully comes to terms with his imminent death.

This engaging memoir describes Pearson's medical training at the University of Texas Medical Branch (UTMB) on
Galveston Island from 2009 to 2016. During these years her personal values
become clear, and she finds fault in her training, in medicine as
practiced in Texas, and even in her own errors in treating patients.
Having left a graduate writing program,
Pearson took a "postbac," a year of pre-med courses in Portland,
Oregon. She interviewed at medical schools "all over the country" and
writes satirically about them; she concludes "nothing out of Texas felt
quite right," having lived there and done her undergraduate work at
University of Texas at Austin. She's a Spanish speaker with a
working-class background. When her classmates provide the annual
“white-trash”-themed party, she wonders, “do I go as myself?” (p. 21).

Pearson's education continues on three tracks:
the formal UTMB courses in medicine, a simultaneous Ph.D. program at the
Institute for the Medical Humanities at the University of Texas, and her
volunteer work at the St. Vincent's Student Run Free Clinic. The Ph.D. program
is off-stage, not mentioned, but the St. Vincent's Clinic becomes pivotal
to her development as a doctor and a moral person.

As for medical school, she finds the relentless
"truths of biochemistry and anatomy" so reductive that the suffering
of people and surrounding politics seem "not to matter at all" (p.
70). Among the politics are: the lack of safety nets for poor people, the use
of uninsured (including prisoners) for students to practice on, failures
to extend Medicare, pollution (notably from the oil industry), losses of
charitable care, and income disparities that include crushing poverty for many.
Something of a rebel, she writes that medical school "felt like junior
high" (p. 44). She does enjoy the "clinical encounters" with
real patients.

St. Vincent's, by contrast, was “a relief.” Her
pages sparkle with her conversation with clinic patients, some
homeless, all poor, and all suffering. She reports--confesses, she even
says--her errors that had consequences for patients. She writes that errors are
an unavoidable part of medical education, but that it's wrong that they should routinely
happen to the poorest members of society.

Chapter 8 discusses depression, which she
felt after the second year. She writes about high rates of suicide among
medical students and doctors; indeed a close friend killed himself during the
"post-doc" year. Because some states require doctors to report
psychiatric care, some doctors avoid such care. This consequence “drives a suicide-prone
population away from the help we may need" (p.92).

The last two years are the rotations through
specialties: surgery, dermatology, trauma, rural medicine,
neurology, internal medicine, and so on. These are clearly and
insightfully described. In one case (internal medicine), she allows the reader
to see the irony of a doctor providing hair removal by laser, diet foods, and
Botox treatment for wrinkles, “a pure luxury transaction” (p. 183).

Pearson describes the storms, hurricanes, and
floods that hit Galveston Island, also the pollution from the oil industry that
causes a “cancer belt” along the Louisiana and Mississippi coasts (p. 104).
At last she finishes her program, understanding
that her identity is simultaneously a person, a physician, and a writer (p.
248).

In this wonderful short story, author Jeanette Brown describes a woman’s first visit to an alternative medicine healer. The woman has a persistent cough. Unhappy with the "five seconds per visit your doctor lavishes on you after your two-hour wait in his sterile lobby," she has taken her yoga instructor’s advice and made an appointment with a tall, olive-skinned man whose voice is "low and soothing" and whose manner is slow, relaxed, and personal.The woman, whom the healer diagnoses as "the roadrunner, a busy fidgety type," alternates between interest, skepticism and dismay. She cracks jokes; he doesn’t laugh. He recommends diet, exercise, no caffeine, and colon cleansing. She mentally rolls her eyes until, his hands massaging her foot, she feels her stomach lurch, a twinge in her armpit and begins to think of her body as "a human pinball machine." Whenever her self-defensive, rational, traditional beliefs almost propel her off the exam table and into her clothes, the healer "nails" her, reading her personality and her lifestyle exactly.Well into the visit, she realizes she hasn’t coughed once. Then, when she’s the most relaxed, incense wafting, his hands kneading all tensions from her back, her mind registering "this is bliss," her esophagus becomes blocked. Sitting up, she coughs, and the healer confronts her. "You have something to say," he insists, and she counters with "You expect me to believe all this mumbo-jumbo?" He tells her she swallows her feelings, and when she coughs again a "feather? A butterfly?" escapes from her mouth and disappears.When the healer pats her back and asks her to cough once more, she can’t. Taking her hands, he declares her "cured." At the story’s end, still not quite able to admit that this strange physician has helped her, yet knowing that he has, the woman struggles to count out his fifty dollar fee, finally dropping a handful of bills onto his bench, "hoping he won’t be offended by a tip."

In-Between
Days: A Memoir about Living with Cancer is an accurate and suggestive title.
At 37, Teva
Harrison was diagnosed with Stage IV breast cancer with metastases to her
bones. She lives between hopes for new treatments allowing a useful life but
also fears about debility—some already caused by her treatments—and death. An
artist, she has created a hybrid of a graphic novel with comic-book style
drawing on the left page and traditional prose facing on the right, with variations
of this format now and then.

The imaginative world of the book
ranges widely in mood, topic, and subject matter, and there is a helpful
organization to group the material.
Her Preface tells us how drawing
helped her gain some power over “the bogeyman that is my cancer” (p. 1).
In her Prologue, she tells of “living
in the shadows,” or “liminal spaces,” but choosing to occupy these as best she
can (p. 3).

Part One lays out the medical facts
and dilemmas. The sections are Diagnosis, Treatment, and Side Effects. The author describes the turmoil of being sick with no clear cause, the emotional impact
of the serious diagnosis on her and her family, also nausea, loss of fertility,
dilemmas of pain management, and many side effects of treatment, including weight
loss as well as sudden and torturous menopause.Part Two explains her social status,
her marriage, her “mixed-bag inheritance” (including high-risk Ashkenazi genes),
and social aspects, including feeling invisible as a patient, accepting help
from friends, being in a support group, and what does a likely “early demise”
mean for her, an atheist?

Part Three explores the many
emotions in sections for hope (using clinical trials, for example), gratitudes
(“At least I’m wasting, not bloating”), wishes, fears, and “Managing Anxiety at
Home” (pictures of yoga, gardening, long walks, house cleaning), self-blame,
and—nonetheless—dreams. The final section “Incurable” names her current status:
“In treatment for the rest of my life,” but the facing picture shows her as a
large powerful bird flying among dramatic clouds with the words “I mean what do
I have to lose?” Her prose affirms: “Live
like a tornado, when I can.”

Robert Lowell: Setting
the River on Fire is “a study of genius, mania, and character” of American
poet Robert Lowell (1917-1977). It is meant
to be neither an autobiography nor a critical study of Lowell’s literary
output, but a study of an artist and his lifelong battle with Bipolar I Disorder,
and an appreciation of how his art and illness were inseparably linked. The
author, Kay Redfield Jamison, is a distinguished psychologist who has been
quite open about her own struggles with the same disease, and whose lifework
consists of exploring the link between Bipolar Disorder and creativity.

Eschewing a purely chronological approach, Jamison divides
her work into sections entitled “Origins,” “Illness,” “Character,” “Illness and
Art,” and “Mortality.” In the first, she traces the history of mental illness
within the poet’s illustrious Boston family.
We learn that Lowell’s great-great-grandmother was institutionalized at
McLean Asylum for the Insane, which was to be the site of several of the poet’s
own hospitalizations. “Illness” is a clinical
case study in prodromal childhood symptoms that progress to full-blown manic
episodes. We follow the progress made by 20th century psychiatry from
psychotherapy and ECT to Thorazine, and, finally, with the introduction of
Lithium, to the possibility of prophylaxis against recurrences.
Later, in “Illness and Art,” Jamison brings her thoughts
about creativity and art to full fruition by discussing what her research reveals
about writers and artists.

Appendices include diagnostic criteria for Bipolar Disorder,
and an explanation of how Lowell’s psychiatric and medical records were made
available by his daughter for the benefit of this volume.

Emergency Doctor is a riveting, informative account of the
workings of the Emergency Department at Bellevue Hospital in New York City, the
oldest public hospital in the country. On
any given day, tourists, residents, the wealthy and those who live in shelters
come to the Emergency Department, some with life threatening injuries and
others who need little more than a hot meal and a shower. No one is turned away.

Published in 1987, the book was written by a former editor
at Reader’s Digest in cooperation with Dr. Lewis Goldfrank, the former Director
of Emergency Services and a leading toxicologist. Goldfrank’s personal story of his path to
emergency medicine and his experience in creating the Emergency Department out
of what was once known as the Emergency Room frame the narrative, but the main
focus is on the day to day activities of the patients and staff in the Emergency Department. Because Bellevue is NYC’s main trauma center,
the book is rich with stories of trauma including construction accidents,
cardiac arrests, fires and suicide attempts among others. Even the title chapters-- "A Question of
Poison," "An Alkaloid Plague," "The Case of the Crazed Executives," for
example—convey the urgency and medical detective work needed for each person
who comes through the triage area. “We don’t know if a patient is alive or dead when we first
see him,” Dr. Goldfrank says. “And we’re
never sure what we’re going to find, or what kind of emergency medicine we may
be called upon to practice—surgery, neurology, pediatrics, psychiatry, cardiology,
obstetrics. (p118)
Accident victims are stabilized in the trauma area and
rushed to the operating room. People with cancer, or TB, children who have been
abused, broken bones, suicide attempts, accidental or intentional poisoning and
overdoses—all must be evaluated and decisions made whether they should be
admitted to a medical floor, the operating room or perhaps kept for
observation.

Beyond medical expertise, however, working in the Emergency Department requires a large dose of compassion to cope with the needs of patients who rely
on the Emergency Department for basic care for their chronic conditions such as asthma, and social
services because they lack a place to live or have no means of support. Perhaps they need to detox from alcohol or have
mental health issues. “Emergency
medicine demands the most intense involvement personally and intellectually,”
observes Dr. Stephen Waxman. “Every area of clinical medicine is practiced, every
emotion is taxed.” (p 119)

Volck’s
memoir describes his medical practice and learning in a variety of settings
(Cleveland, Baltimore, Cincinnati), but, more importantly, in non-metropolitan
places, such as Tuba City on the Navajo Reservation in Arizona and rural
clinics in Honduras. He suggests that his knowledge of medicine has largely
come as he has practiced it and not from his formal education. Further, he
believes that best medical practice is not primarily high-tech, urban, or
industrial. Each of the 15 chapters has a title—a topic, a person, or a
theme—but also one or more locations specified. For example, we have “Chapter
One, A Wedding, Navajo Nation, Northern Arizona,” suggesting the importance of
culture and locale. Further, the chapters include personal associations from
several realms beyond the topic and place as Volck seeks to understand medicine,
healthcare, and how we live in the world.

Of the
first seven chapters, five are set in Navajo land, where Volck is an outsider
by his cultural heritage and his profession, a doctor with a pediatrics
specialty. From time to time he reflects on his training, the English verb “to
attend,” and specific patients, such as two-year-old Alice in Tuba City and
eight-year-old Brian in Cleveland. Both children died while in his care. Working
on the front-line of medicine, he considers the weaknesses of our modern
attitudes toward death and our wishes for control. He also wrestles with personal
lifestyle issues of balancing medicine, family, and an urge to write. Other
chapters describe restlessness in his profession, the growth of his family
(including the adoption of a Guatemalan baby girl), hiking in the Grand Canyon,
camping in the rain, and a retreat with Benedictine monks. Chapter 11
“Embodying the Word” discusses literature and medicine, lectio divina (a Benedictine reading practice), and the need to
listen carefully to patients’ stories.The final
chapter returns to Cincinnati, Honduras, and Tuba City. Volck has found more
projects in the Navajo Nation, including a youth service project from his
church. With permission, he conducts interviews and plans a book on the Navajo,
“drawing on cultural history, anthropology, history, medicine, and politics”
(p. 201).

This film focuses on the interaction between 5-year-old Alexandria and Roy, a Hollywood stuntman in the early days of film. The two are residents of a rehabilitation hospital, and both are recovering from falls they’ve taken: he’s paralyzed from the waist down as a result of a failed stunt; she’s broken her humerus as the result of a fall she’s taken in an orange orchard. (A child in a migrant family, she’s been tasked, at 5 years of age—presumably out of economic necessity—with climbing ladders to pick oranges.) Having accidentally intercepted an affectionate note—Alexandria’s child-missive—meant for the kindly but preoccupied nurse Evelyn, paralyzed Roy befriends the girl and quickly wins her over by telling her the wondrous tale of a masked bandit and his companions, all of whom have been betrayed by the evil emperor Odious, and all of whom are united in their quest for vengeance against the ruler. While Roy narrates the story, we see it take place through Alexandria’s eyes, and the characters she envisions are drawn from people in her life. The role of the heroic masked bandit she assigns to Roy himself, blended to a poignant degree with her deceased father. Alexandria sometimes interrupts and asks questions about or challenges the story’s development, whereupon Roy makes adjustments: it’s clear that the story is a co-constructed project. Roy has, however, become increasingly despondent over his paralyzed condition and over the fact that his fiancée has broken off the engagement as a result of Roy’s condition. As time goes on, Roy uses his unfolding story as a means of manipulating Alexandria to retrieve morphine from the hospital dispensary. He tries and fails to commit suicide with the pills that Alexandria supplies. In the process, he winds up bringing about a severe injury to the child. Filled with remorse and guilt, Roy alters his story such that it can be a source of separation between him and the girl: it becomes cruel and violent, and suggests that the hero is a weak, inglorious imposter who deserves to die. The anguished Alexandria protests, demanding that Roy change the story. Roy refuses, insisting that “It’s my story.” But Alexandria retorts, “It’s mine, too.” And Roy relents. The masked bandit of the story is redeemed, and Roy himself is as well. The film closes first with Roy, Alexandria, the hospital patients and staff watching the film in which Roy’s acting had led to his accident. As the scene approaches the point where the accident had occurred, Roy feels understandable anxiety; but the film has of course been edited. Roy is relieved, but turns to Alexandria, in the hopes that she is not terrified. He finds her beaming. Then the film we are watching, The Fall, shifts to a rapid series of black-and-white footage of stunts—the effect is reminiscent of the love scenes gathered at the end of Cinema Paradiso—narrated by the marveling Alexandria. Each clip features a person in imminent, catastrophic danger—who is then impossibly rescued at the last second by fortunate chance. As Alexandria blows us kisses through a character who is falling backward, we are left in a state of bewildered gratitude over this strange gift of stories we human beings offer each other—stories that assure us over and over again how, confronted with the calamities we see no way of escaping, we are nonetheless saved.

A rare patient narrative from 1812 describes a mastectomy performed before the introduction of anesthesia. This letter from Frances d'Arblay (1752-1840) (née Frances [Fanny] Burney), addressed to her older sister, Esther, details her operation in Paris by one of Napoleon's surgeons.In her childhood and youth, Fanny Burney moved in the best London society; she was a friend of Dr. Johnson who admired her. She served five years at the court of George III and Queen Charlotte as Second Keeper of the Royal Robes (1786-1791). Fanny Burney married Adjutant-General in the army of Louis XVI Alexandre-Jean-Baptiste Piochard d'Arblay in 1793. He had fled to England after the Revolution. They lived in England and spent ten years in France (1802-1812).Burney's mastectomy took place 30 September 1811. The patient wrote about her experience nine months later. She chronicles the origin of her tumor and her pain. She is constantly watched by "The most sympathising of Partners" (128), her husband, who arranges for her to see a doctor. She warns her sister and nieces not to wait as long as she did. At first resisting out of fear, the patient agrees to see Baron Dominique-Jean Larrey (1766-1842), First Surgeon to the Imperial Guard.He asks for her written consent to guide her treatment; her four doctors request her formal consent to the operation, and she makes arrangements to keep her son, Alex, and her husband, M. d'Arblay, away. Her husband arranges for linen and bandages, she makes her will, and writes farewell letters to her son and spouse. A doctor gives her a wine cordial, the only anesthetic she receives. Waiting for all the doctors to arrive causes her agony, but at three o'clock, "my room, without previous message, was entered by 7 Men in black" (136).She sees "the glitter of polished Steel" (138). The extreme pain of the surgery makes her scream; she feels the knife scraping her breastbone. The doctors lift her up to put her to bed "& I then saw my good Dr. Larry, pale nearly as myself, his face streaked with blood, & its expression depicting grief, apprehension, & almost horrour" (140).Her husband adds a few lines. These are followed by a medical report in French by Baron Larrey's 'Chief Pupil'. He states that the operation to remove the right breast at 3:45pm and that the patient showed "un Grand courage" (141). She lives another twenty-nine years. It is impossible to determine whether her tumor was malignant.

The Renewal of Generosity:
Illness, Medicine, and How to Live contemplates the phenomenon of
generosity as it is realized in the stories of physicians and patients. For Arthur Frank, generosity is grounded in
the willingness of people to give themselves over to dialogical processes of
communication wherein participants best realize themselves through relational
engagement: generous, dialogical communication leads to a renewal and
realization of human being. Health
care systems today tend to impede communicative generosity, however, and the
result is a de-humanization and de-moralization of both physicians and
patients. As a remedy, Frank proposes,
first, that we re-figure our conceptualization of the physician-patient
relationship—from the economic or business metaphor of “provider” and “client,”
we should turn to the metaphorical conceptualization of “host” and “guest,”
which clearly has implications for manner of treatment and communication that
occurs in the relationship. In addition,
Frank turns to and thinks with stories of physicians and stories of the ill to
reflect on the ways that generosity is realized. Drawing on the wisdom of the striking
philosophical triumvirate of Marcus Aurelius (Stoicism), Mikhail Bakhtin
(Dialogism), and Emmanuel Levinas to amplify the reflections
emerging from the physician and patient stories, Frank ultimately proposes
“exercises” for training to generate a vivifying generosity within the medical
profession, which can in turn lead to a re-humanization and re-moralization for
physicians, improved care for patients, and enhanced flourishing for all.